Healthcare Provider Details

I. General information

NPI: 1922044429
Provider Name (Legal Business Name): LLOYD W NETHERCUTT JR. OD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 BULTMAN DRIVE
SUMTER SC
29150
US

IV. Provider business mailing address

PO BOX 5721
COLUMBIA SC
29250
US

V. Phone/Fax

Practice location:
  • Phone: 803-773-4723
  • Fax: 803-775-5211
Mailing address:
  • Phone: 803-779-2273
  • Fax: 803-799-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number615
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: